Political support for single payer still falls short of the threshold needed

On health care, Democrats are shifting to offense

By Ricardo Alonso-ZaldivarAssociated Press, January 8, 2018

Democrats are shifting to offense on health care, emboldened by successes in defending the Affordable Care Act. They say their ultimate goal is a government guarantee of affordable coverage for all.

With Republicans unable to agree on a vision for health care, Democrats are debating ideas that range from single-payer, government-run care for all, to new insurance options anchored in popular programs like Medicare or Medicaid.

Democrats are hoping to winnow down the options during the 2018 campaign season, providing clarity for their 2020 presidential candidate.

Obama’s former health secretary, Kathleen Sebelius, says she sees Democrats reclaiming a core belief that health care should be a right guaranteed under law.

Here’s a sample of ideas under debate by Democrats and others on the political left:

Medicare for All: Vermont Sen. Bernie Sanders made single-payer, government-run health care the cornerstone of his campaign for the 2016 Democratic presidential nomination. It remains the most talked-about health care idea on the left.

Medicare-X: The legislation from Sen. Tim Kaine, D-Va., and Sen. Michael Bennet, D-Col., would allow individuals in communities lacking insurer competition to buy into a new public plan built on Medicare’s provider network and reimbursement rates.

Medicare Part E: Yale University political scientist Jacob Hacker has proposed a new public health insurance plan based on Medicare, for people who don’t have access to job-based coverage meeting certain standards. He’s working with Democrats in Congress to turn the concept into legislation.

Medicaid Buy-In: Sen. Brian Schatz, D-Hawaii, and Rep. Ben Ray Lujan, D-N.M., have introduced legislation that would allow states to open their Medicaid programs up to people willing to pay premiums.

Expect more ideas as the year unfolds, said Neera Tanden, president of the Center for American Progress and a former top aide to Obama as well as Hillary Clinton. “Democrats are much more comfortable with an expansionist view,” said Tanden. “Almost every Democrat is talking about truly universal health care.”

But in Sanders’ home state of Vermont, primary care physician Dr. Deborah Richter says she believes it’s only a matter of time before the Unites States adopts single-payer. Activists who failed in an earlier attempt in the state are now focused on passing a plan that would cover just primary care.

“I think the next election will be a move to the left,” said Richter. “Whether Democrats will be willing to go for the whole system is pretty doubtful. I feel it might be possible for us to do it in phases.”

Comment:

By Don McCanne, M.D.

Single payer advocates can be encouraged by the improved understanding and greater support of the single payer Medicare for All concept engendered by the campaign of Sen. Bernie Sanders. The Republican politicians continue to reject the concept, but just how much support is there amongst the Democrats in office?

About one-third of the Democrats in the Senate have signed on as cosponsors of S. 1804, Sen. Sanders' Medicare for All Act, but they did so knowing that it was a safe move - it could not possibly pass and be signed in the 115th Congress. Many of them actually support incremental measures that build on the current system as being more feasible politically (and less offensive to the campaign supporters of some of them - the insurers and pharmaceutical firms).

In spite of the national support for single payer, many of the Democrats in office are supporting, as their preference, incremental measures such as Medicare-X, Medicare Part E, and Medicaid Buy-In. Neera Tanden, who helped lead the forces that prevented single payer from being included in the last Democratic Party platform, is giving lip service to "an expansionist view," but you can be sure that her view of expansion falls far short of single payer. Even some of the most respected single payer activists within our own camp have grown frustrated after a couple of decades of effort with no results and thus support phasing in single payer incrementally.

Why shouldn't we go ahead and support the incremental proposals? Isn't expanding coverage to include more individuals better than holding firm to a fight that we haven't been able to win so far? The problem is that support for the golden standard of single payer reform is inversely proportional to the perceived need. If we continue to tweak the system so that it is at least barely tolerable for the majority, then we cannot meet the political threshold required to enact a bona fide single payer system.

You might say, "So what, if we're most the way there, isn't that good enough?" But limiting ourselves to the goal of providing nominal health care coverage for a large majority of U.S. residents not only leaves out those who do not qualify or can't afford it, but it leaves in place all of the other deficiencies that would be corrected by a well-designed single payer system. Under single payer, people would have their choice of health care professionals and institutions. Financial barriers to care, such as high deductibles, would be eliminated. Separate planning and budgeting of capital improvements would improve access. A massive reduction in administrative waste along with adoption of the other efficiencies of a single payer system would redirect wasted funds to programs that we all support (such as health care for the currently underserved, education, infrastructure, etc.).

Medicare-X, Medicare Part E, Medicaid Buy-In, and a program limited to primary care might be nice improvements, but they alone do not scratch the surface of what we need to do. We have just gone through another decade without real reform because we went along with the Affordable Care Act, and costs have continued to increase, financial barriers have increased, choices of providers have decreased, and waste has not been reduced.

We can do it, but we need greater democracy in America. Big business and the very wealthy now control our government. Benjamin Page and Martin Gilens in their book, "Democracy in America?," explain what has gone wrong and what we can do about it. It will not be easy, but action is an imperative. The book is described in a recent Quote of the Day available at the following link:http://www.pnhp.org...Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.